Hospice

Hospice provides comprehensive and interdisciplinary health care to terminally ill patients, as well as bereavement and support services to the patients’ loved ones. Patients receiving hospice care forgo curative treatments. Hospice care is provided through certified hospice programs, and may be delivered in any patient care setting, but is most often provided in the patient's home.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective hospice health care services.

Hospice provides comprehensive and interdisciplinary health care to terminally ill patients, as well as bereavement and support services to the patients’ loved ones. Patients receiving hospice care forgo curative treatments. Hospice care is provided through certified hospice programs, and may be delivered in any patient care setting, but is most often provided in the patient’s home.

CHA provides state and federal representation and advocacy in the legislative and regulatory arenas to improve access to quality, cost-effective hospice health care services.

In its June report the commission continues its work, required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, evaluating the feasibility of a unified prospective payment system (PPS) spanning post-acute care (PAC) settings (e.g., skilled-nursing facility, inpatient rehabilitation facility, long-term care hospital and home health agency). After determining a unified PPS is feasible in its 2016 report, the commission studied three implementation issues: a transition period with blended setting-specific and unified PPS rates, appropriate levels of aggregate PAC payments, and ways to address ongoing refinements to the system after implementation. MedPAC recommends that a unified PAC PPS be implemented beginning in 2021 with a three-year transition, and that aggregate payments should be reduced by 5 percent.

On April 27 the Centers for Medicare & Medicaid Services (CMS) issued the attached proposed rule updating the federal fiscal year (FFY) 2018 payment rates and wage index for hospices. Overall, CMS anticipates that aggregate hospice payment rates will increase from FFY 2017 levels by 1 percent, or about $180 million. The proposed cap for FFY 2018 would be $28,689.04.

The proposed rule also specifies public reporting measures derived from the CAHPS Hospice survey, provides an update on the Hospice Quality Reporting Program and solicits comments on clarifying regulations on sources of clinical information for certifying terminal illness.

CMS also releases a request for information to welcome continued feedback on the Medicare program and to solicit ideas for regulatory, sub-regulatory, policy, practice and procedural changes to support increases in quality of care and decreasing costs.

The Medicare Payment Advisory Commission (MedPAC) has released draft recommendations on Medicare fee-for-service payment and policy changes as well as Medicare Advantage, as required by law. These recommendations, directed at Congress and the Department of Health and Human Services Secretary, are for calendar and federal fiscal year (FFY) 2018.

The presentations made by MedPAC staff at the December meeting, along with the meeting transcript, are available on the MedPAC website. During its January meeting, the commission voted unanimously to accept each of the draft recommendations to present to Congress in their March report.

MedPAC’s specific draft recommendations include:

Hospital inpatient and outpatient payments: MedPAC noted that cost growth remains low but that further reductions in uncompensated care payments — combined with estimated future cost growth — have contributed to continued negative Medicare margins. In 2015, overall Medicare margins were negative 7 percent. MedPAC projects that margin to decrease further, to negative 10 percent, in 2017. Despite these negative projections, MedPAC noted that access to care and capital remain sufficient and that quality of care is improving, with steady decreases in readmission and mortality rates in hospitals. MedPAC recommends that Congress retain the inpatient and outpatient update amounts specified in current law. MedPAC estimated that update will be approximately 1.85 percent for FFY 2018; however, this estimate does not include any adjustments related to the coding offset or the restoration of payments from the two-midnight policy. The commission also reiterated its strong support for site-neutral payment policies for hospitals.